How do teens quit vaping? Some simply send a text for help, new study shows

By Jacqueline Howard, CNN

(CNN) — For teens who want to stop vaping nicotine, an interactive text message program was found to be effective at helping them quit.

The anonymous program begins with this message: “Ready to quit? Text the date you want to quit for daily tips a few weeks before and after your quit date.”

Among adolescents with a history of vaping, those who participated in a first-of-its-kind text message program called This is Quitting were 35% more likely to report that they had quit vaping after seven months compared with adolescents who did not participate in the program, according to a study published Wednesday in the medical journal JAMA.

This is Quitting was developed by Truth Initiative, a nonprofit focused on ending tobacco use, as a free and anonymous text messaging program to help young people quit vaping. Before this study — which Truth Initiative funded — there hasn’t been any data available on how to help teens quit vaping, according to the researchers.

“This is the first study to demonstrate the effectiveness of any quit vaping program for adolescents. It’s also a program that has been used by more than 780,000 young people nationwide since Truth Initiative launched it in 2019,” Dr. Amanda Graham, chief health officer at Truth Initiative and principal investigator of the study, said in an email.

“This study is the first to show the effectiveness of a digital intervention in helping young people break free from e-cigarettes,” she said. “The text message intervention helped them build confidence to overcome nicotine addiction and learn powerful behavior change skills that they can take with them for life.”

E-cigarettes are the most commonly used tobacco product among adolescents.

The 2023 National Youth Tobacco Survey, released in November by the US Centers for Disease Control and Prevention and the US Food and Drug Administration, found that about 2.1 million middle and high school students were e-cigarette users.

How the program works

The new study included more than 1,500 adolescents in the United States, ages 13 to 17, who reported vaping in the previous 30 days, with many of them — about 76% — reporting that they vape within 30 minutes of waking up, a signal of nicotine dependence.

Most of the study participants, about 87%, reported that they had tried to quit in the previous year, and about 94% reported feeling somewhat or very addicted to vaping.

The trial participants were recruited via ads on social media, including Instagram, Facebook and Snapchat. From October 2021 to October 2023, about half of the participants were randomly assigned to the This is Quitting text message program.

The text message program included messages designed to build confidence and skills for quitting, including cognitive and behavioral coping strategies, mindfulness training, breathing training, self-care advice, social support, information about cessation medication and how to reach the Crisis Text Line.

Some of the text messages in the program include: “Drinking something cold – water, sports drink, iced tea, milk – can help when a craving pops up. You can always reply COPE.” or “You GOT this. You may want to avoid people, places, or things that make you want to use your vape today (if that’s possible). Text COPE or STRESS if you need.” The messages also include tips from other young people who are also quitting.

The participants were encouraged to set a quit date and were asked about their vaping behavior via follow-up text message assessments.

The other study participants, who were not put in the program, received only the follow-up text message assessments. Those assessment texts included messages such as “How’s the quit going?” or “Have you cut down how much you vape nicotine in the past 2 weeks?”

There were also participants in a “waitlist” group, who received neither text messages through the This is Quitting program nor the assessment-only follow-up messages.

The researchers — from Truth Initiative and Brown University — found that after seven months had gone by, about 38% of participants in the This is Quitting program reported not vaping in the previous 30 days, compared with 28% in the assessment-only group.

Among adolescents who both vaped and smoked traditional cigarettes, a higher proportion in the This is Quitting program, about 51%, reported not vaping nor smoking at seven months, compared with 30% of the assessment-only group.

“Text messaging is a scalable and cost-efficient approach to delivering vaping cessation treatment on a population basis,” the researchers wrote in the study.

“National guidelines recommend that pediatric health care professionals screen all adolescents for e-cigarette use. The intervention evaluated here can be a resource for clinicians whose patients express interest in quitting vaping,” the researchers added. “Placing information about the intervention in clinics and waiting rooms may encourage intervention use among those who do not disclose their vaping.”

A study published in 2021 found that among more than 2,500 young adult e-cigarette users, ages 18 to 24, about 24% who participated in the This is Quitting program reported that they had stopped vaping after seven months, compared with about 19% in the assessment-only group.

Graham said she was surprised the quit rates among adolescents in the new trial were higher than those among young adults in the previous study.

“This may point to the changing norms around e-cigarette use and the fact that quitting vaping among young people is becoming more normative and accepted,” she said.

People can join the This is Quitting program for free by texting DITCHVAPE to 88709. The program is available only in the United States.

A growing need for solutions

The new study included a diverse group of adolescents, indicating how the text message program could be helpful for marginalized communities, said Dr. Suchitra Krishnan-Sarin, a professor of psychiatry at the Yale School of Medicine.

“What is noteworthy is the diverse demographics of the youth who participated which is very representative of both this age group and of those who use e-cigarettes,” Krishnan-Sarin, who was not involved in the new study but has been following the research released by the Truth Initiative, wrote in an email.

About 43% of the study participants were LGBTQ+ adolescents, for instance, and research suggests that LGBTQ+ young people smoke and vape at a higher prevalence than their non-LGBTQ+ peers.

“There are few, if any, validated interventions for youth vaping cessation. So, programs like this one are critical to support youth in their vaping cessation efforts,” Krishnan-Sarin said. “I would recommend this type of program to youth who want to quit vaping. Many schools use punitive measures to address vaping which are known to not be effective.”

The new study is important because there are few e-cigarette cessation programs that are free of cost and accessible for adolescents, Dr. Bonnie Halpern-Felsher, a developmental psychologist at Stanford University, wrote in an editorial published alongside the study in JAMA.

She added that there is also an “absence of studies” on the effects and dosage of nicotine replacement therapy, or NRT, for adolescents as a way to help them quit vaping. Nicotine replacement therapy is the family of medications used to help adults quit using nicotine, including over-the-counter patches, gums or lozenges or prescription inhalers or nasal sprays.

“Furthermore, the US Food and Drug Administration has not approved NRTs for anyone younger than 18 years (although many health care professionals prescribe NRTs for adolescents, as is recommended by the American Academy of Pediatrics). As such, it is imperative that e-cigarette cessation programs focused on adolescents are developed, evaluated, and implemented,” Halpern-Felsher wrote.

“The need for evidence-based e-cigarette prevention and cessation programs that are accessible and easy for adolescents to use, and that provide adolescents with developmentally appropriate information and support, is great,” she said. “This is Quitting is one such effective program, showing that evidence-based cessation programs for adolescents can and should be implemented and widely disseminated to address adolescent e-cigarette use.”

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